Variations in Oncology Consultations: How Dictation allows Variations to be Documented in Standardized Ways

Abstract

In-between 2016 and 2017 a new hospital information system (HIS) was introduced at several hospitals in Denmark radically changing the core work practices for a majority of the healthcare professionals. Promptly, the new HIS began to receive criticism from healthcare professionals for failing to live up to proclaimed expectations. To fully understand the problems experienced by the healthcare professionals we need to understand the fundamental nature of the work prior to the implementation. In this paper, we investigate patient consultations as they were performed prior to the implementation of the HIS at an oncology department. Reporting from a 1.5 year-long study, we find patient consultations were organized in three sequential activities: review, interaction, and documentation. Further, we find that the dictaphone served as a key artifact allowing physicians to enact flexibility in documentation while simultaneously providing them with the capability to communicate and coordinate with the medical secretaries. Our empirical findings suggest that the medical secretaries are critical for structured documentation of variations in health data and are the cornerstones that allow physicians to enact sentimental efforts when interacting with patients. These insights prove important in understanding the criticism aimed at the new HIS implementation since the implementation removed the dictaphone as a key artifact and instead introduced a new organizational structure where documentation was assumed accomplished in parallel with patient interaction. The transformation consequently shifted work, previously performed by the medical secretaries, to the physicians.